In-depth look at Schizoid Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.
Schizoid personality disorder (SZPD) is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. People with schizoid personality disorder also tend to be distant, detached, and indifferent to social or close relationships. They generally are loners who prefer solitary activities and rarely express strong emotion. This person's life is marked by little pleasure in activities. People with this disorder appear indifferent to the praise or criticism of others and often seem cold or aloof. People with schizoid personality disorder are rarely violent, as they prefer not to interact with people.
Although the names sound alike and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. Many people with schizoid personality disorder can function fairly well. They tend to choose jobs that allow them to work alone, such as night security officers and library or laboratory workers.
It is difficult to accurately assess the prevalence of this disorder because people with schizoid personality disorder rarely seek treatment. Schizoid personality disorder affects men more often than women and is more common in people who have close relatives with schizophrenia. Schizoid personality disorder usually begins in early adulthood.
They do not desire or enjoy close relationships, even with family members.
They choose solitary jobs and activities.
They take pleasure in few activities, including sex.
They have no close friends, except first-degree relatives.
They have difficulty relating to others.
They are indifferent to praise or criticism.
They are aloof and show little emotion.
They might daydream and/or create vivid fantasies of complex inner lives.
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
neither desires nor enjoys close relationships, including being part of a family
almost always chooses solitary activities
has little, if any, interest in having sexual experiences with another person
takes pleasure in few, if any, activities
lacks close friends or confidants other than first-degree relatives
appears indifferent to the praise or criticism of others
shows emotional coldness, detachment, or flattened affectivity
Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid)."
Little is known about the cause of schizoid personality disorder, but both genetics and environment are suspected to play a role. Some mental health professionals speculate that a bleak childhood where warmth and emotion were absent contributes to the development of the disorder. The higher risk for schizoid personality disorder in families of schizophrenics suggests that a genetic susceptibility for the disorder might be inherited.
It is likely that a sustained history of isolation during infancy and childhood with encouragement and modeling of interpersonal withdrawal, indifference, and detachment by parental figures contributes to the development of schizoid personality traits.
There are no laboratory tests for schizoid personality disorder, and diagnosis usually comes after a thorough clinical interview. During this interview, the doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination can help rule out other conditions, and a mental health professional will likely be consulted for further evaluation.
In order for someone to receive a diagnosis of schizoid personality disorder, he or she must meet at least four of the following criteria:
Neither desires nor enjoys close relationships, including being part of a family
Almost always chooses solitary activities
Has little, if any, interest in sexual experiences with another person
Takes pleasure in few, if any, activities and rarely experiences strong emotions
Lacks close friends or confidantes other than first-degree relatives
Appears indifferent to praise or criticism
Shows emotional coldness, detachment or flattened emotions
In addition, the symptoms must not occur exclusively during a bout of schizophrenia, a mood disorder with psychotic features, another psychotic disorder or a pervasive developmental disorder (such as autism or Asperger's syndrome). Also, a diagnosis of schizoid personality disorder may not be
Further complicating a diagnosis is that the symptoms of schizoid personality may resemble autism or Asperger's syndrome.
Persons with Schizoid Personality Disorder (SZPD) rarely present for treatment, whether it is for their schizoid traits or a co-existing Axis I disorder. They feel little need for treatment, as their isolation is often ego-syntonic (compatible with their ego). Their social isolation is of more concern to their relatives, colleagues, or friends than to themselves.
If persons with SZPD are seen for treatment for a concomitant Axis I disorder (e.g., a sexual arousal disorder or a substance dependence), it is advisable to work within the confines and limitations of the schizoid personality traits.
It is also important not to presume that persons with SZPD are simply inhibited, shy, or insecure. Such persons are more appropriately diagnosed with Avoidant Personality Disorder.
When they do come into treatment, a person with schizoid personality disorder can have trouble communicating with a therapist and react in a bland, detached manner. However, when a doctor shows respect for their personal space and private thoughts, people with a schizoid personality can respond effectively to treatment.
Schizoid personality disorder is generally treated with psychotherapy. Types of psychotherapy vary, ranging from psychodynamic therapy to group therapy. Since personality disorders cause distorted thought patterns, cognitive-behavioral therapy is often particularly effective in helping individuals adjust their thinking and behavior patterns.
One may not be able to increase the desire for social involvements but one can increase the ability to relate to, communicate with, and get along with others. Persons with SZPD may not want to develop intimate relationships but they often want to interact and relate more effectively and comfortably with others. Role-playing and videotaped interactions can at times be useful in this respect. Group therapy is often useful as a setting in which patients can gradually develop self-disclosure, experience the interest of others, and practice social interactions with immediate and supportive feedback.
There's no specific drug treatment for schizoid personality. Medications are sometimes utilized in combination with psychotherapy. Drugs such as antidepressants, anti-psychotics, and anti-anxiety medications are commonly used to alleviate the associated symptoms of depression and anxiety. For example, the psychological inability to experience pleasure can be treated with bupropion (Wellbutrin). Risperidone (Risperidal) or Olanzapine (Zyprexa) can help with flattened emotions and social problems.
Medications are best used in combination with some form of psychotherapy and are not recommended as a sole treatment for personality disorders.
Harry Croft, MD (Psychiatrist)
Medical Director, HealthyPlace.com
Created on 13 November 2008 Last Updated on 01 October 2013